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.Therefore,Arginase deficiency Deprivationit provides a basic understanding of the level of involvement ofSjögren  Larsson syndrome Malnutritiona child for all those involved in caring for the child.The use ofMetachromatic leukodystrophy Non-motor handicaps the GMFCS is becoming increasingly common in CP clinics as(blindness)a universal tool for communication with colleagues, determiningLesch - Nyhan syndromeMotor handicapsthe prognosis and planning treatment.Joubert syndrome(spina bifida, myopathies)Some scales and suggestions for further reading are providedChiari Type I malformationin the appendix.Dandy - Walker syndromeDifferential diagnosisAngelman syndromeOne needs to distinguish CP from progressive disorders ofGillespie syndromechildhood [A].It may not be always necessary to find the exactMarinesco - Sjögren syndrome cause because this does not change the management for mostchildren (with the exception of inborn errors of metabolism thatAtaxia - Telangiectasiacan be cured).Mental retardation syndromes, attention deficitHexoaminidase A and B deficiencydisorder, autism and non-motor handicaps such as blindness andBehr syndromeemotional disorders also cause motor delay [B,C].CognitiveSerotendinosus xanthomatosisproblems are prominent in all these syndromes except forblindness.On the contrary, motor problems are predominant inCP.All children with suspected motor delay should be seen by aEarly differential diagnosis in developmental disabilitypediatric neurologist to assess for differential diagnoses.CCCerebral palsy Mental retardationImaging studiesRisk factors Often positive Mostly absent Imaging studies enable the physician to define the type andlocation of the brain lesion and to differentiate progressiveComplaints Irritable, sleepless baby Easy babyneurological syndromes.Milestones Delayed DelayedRadiologyExamination Delayed growth or negative Negative or a syndromeThe primary indication to perform radiography in cases ofMuscle tone Increased HypotoniaCP is to monitor hip instability.Obtain baseline spine and hipPrimitiveradiographs in every child and follow the hip at risk with hipPersist Normal disappearancereflexesradiographs [D].Measure the Reimer s index which is thePosturalDelayed appearance Delayed appearance percentage of femoral head coverage by the acetabulum.Three-reflexesdimensional CT is useful when planning hip reconstruction [E].Focal signs Appear AbsentClinical examination is sufficient to diagnose and follow-upscoliosis.Measure the Cobb angle in children who are candidatesfor surgery [F].Obtain radiographs of the extremities for patientsDDif you plan osteotomies.Standing radiographs of the feet help ifthere are varus/valgus deformities.Cranial ultrasonography (USG)Cranial USG [G] can help in the differential diagnosis of the infantwhen the fontanelle is open.It is easy and it does not requiresedation as does MRI.Cranial USG evaluates the ventricles,basal ganglia and corpus callosum.Periventricular white matterEE ischemic injury and intraventricular haemorrhage are apparenton real-time cranial ultrasonograms.Radiographies are the standardevaluation method for hip insta-Cerebral computerized tomography (CT)bility.A three dimensional CTCT is helpful in the diagnosis of intracranial bleeding in thescan provides valuable data innewborn, it may be helpful in evaluating congenital malformationsthe preoperative evaluation forhip reconstruction.and PVL [H] but in these and other lesions MRI is superior.Cranial magnetic resonance imaging (MRI)FFMRI is the best method for diagnosing lesions in the whitematter after 2 to 3 weeks of age [I,K].At present, MRI andIHH IKKGGEvaluate scoliosis withCranial ultrasoundPorencephaly on cranial Periventricular Porencephaly on MRIradiographiesCT leukomalacia on MRIPhysical Examination25ultrasonography are the only methods to show periventricularAAleukomalacia in an infant from 1 week of age.No biochemicalmethods are available to identify high-risk infants at birth.Electroencephalography (EEG)EEG measures electrical activity on the surface of the brain.It is a necessary tool in the diagnosis and follow-up of seizuredisorders.Explanation of the diagnosis to parentsThe diagnosis takes time.The child must be at least 1 year oldbefore a definite diagnosis can be made, especially in casesin which the lesion occurs during the prenatal or perinatalstage (approximately 80% of all CP cases).The infant with acerebral dysfunction shows signs of neurodevelopmental delayat initial examinations.Tone abnormalities such as spasticityand dystonia, or disorders of movement such as ataxia appeargenerally at or after 12 months of age, when it will be possibleto name the movement disorder as CP.How to explain the diagnosis to the parents?Wait until the childhood period for a definite diagnosis.For a baby:Provide those babies who show delayed development with anYour baby has had an injury to his brain.He is developing a little sloweradequate exercise program to stimulate the CNS.In the eyes ofthan his peers.He may have problems with movement.The outlookthe society the diagnosis of CP labels the child as handicappeddepends upon how serious or how extensive the brain damage is.Be-or abnormal.Be cautious about the diagnosis.Avoid initial cause he is a baby, right now it is diffi cult to tell what the future out-look will be eventually.We have to follow him carefully, he has to haveuse of the term cerebral palsy to the parents because of thetherapy and we will see how he will develop.All children develop along astigma.Instead, describe the child s symptoms and why theycertain pathway.Children who have this brain injury that we call cerebraloccur [ Pobierz caÅ‚ość w formacie PDF ]